Insights From our Trainers: Using the Brazelton Approach to Support Infant Development

By Betty Hutchon, Brazelton Master Trainer

Having worked as a neonatal neurodevelopmental occupational therapist for more than 30 years I’ve learnt the importance of using assessments and/or observational tools which will inform and lead my interventions. In a role which encompassed assessing the infant holistically and understanding the impact of one area of development on another I was greatly impressed by the detailed information and much deeper understanding of the infant I could gain from administering the NBAS (Neonatal Behavioural Assessment Scale).

This proved to be hugely beneficial when working with parents and designing early intervention programmes for their infant. Then with the publication of the NBO (Newborn Behavioural Observations) in 2007 and it’s focus on relationship building, as opposed to assessment, it brought another dimension by illuminating the importance of relationships in development. We know the brain is sculpted by the quality of early relationships and parent-child synchrony has been shown in research to be related to better cognitive development.

We often discuss how the NBO and NBAS help parents understand their infant’s behaviour and enhance parent- infant interaction but I am going to focus here on how the NBO and NBAS can be used to advance infant development.

There are 3 key areas which are important to consider when using the NBO and/or the NBAS for the purpose of enhancing newborns’ development.

Habituation
State organisation
Regulatory behaviours and Self Consoling

Habituation:

Habituation can be viewed as the earliest form of learning and is something we all do when we’re awake and asleep. In the NBO and NBAS we look at how the sleeping baby responds to external stimuli such as light and sound. Many babies will habituate with ease whilst other babies will be very disturbed and even wake up demonstrating challenges with protecting their sleep. This has consequences for many aspects of development including – weight gain, energy levels for feeding, play and learning and of course mood when awake – a tired baby is often irritable and unsettled.

Supporting a baby’s ability to habituate and sleep well brings gains in physical growth, feeding skills, play and learning.

It is important that clinicians assess or observe habituation in the babies they work with and understand how identifying those difficulties should influence the intervention plan.

Clinicians should discuss sleep and sleep protection with parents when working with a baby who is irritable or not feeding well or is failing to gain weight as expected.

State Organisation:

The concept of 6 behavioural states was first published by Peter Wolff in 1959 and subsequently incorporated into the NBAS in recognition of the importance of state when observing behaviour.

Each state makes its own unique contribution to infant development but it is state 4 where the infant feeds well, plays and learns and develops communication and attention skills. The focus of our work in early intervention is helping the baby play and learn so identifying challenges with achieving and maintaining state 4 is crucial.

Assessment or observation of the range of states available to the baby is relatively straightforward when administering the NBAS or NBO but knowing how to promote state 4 is more difficult. However this is crucial in an early intervention programme. There are many factors which could impact on a baby’s ability to achieve or maintain a robust state 4 – consider medical history, maturity and diagnosis.

Consider ways to support state 4 when the baby is awake – for example swaddling and positioning can have a very big impact on alertness as can gentle linear rocking up and down which can help a baby open their eyes.

Regulatory behaviours and self consoling:

Regulatory behaviours have an impact on physical development as well as helping the infant maintain and transition between states. Regulatory behaviours allow a baby to move and learn.

Babies use what is sometimes described as simple motor behaviours such as bringing their hands to their mouth or to midline to help them regulate their emotions and state and settle down. However, these motor behaviours may not be that simple for many babies with additional needs – their head control may be poor limiting midline orientation and hand mouth co-ordination. Difficulty with quieting down movements or an inability to decrease motor activity to stay still impacts hugely on a robust state 4. As mentioned above the inability to maintain state 4 impacts on attention, learning and communication.

Research shows there are school aged and longer term consequences for poor regulatory behaviours. Yet we know much can be done to support the acquisition of regulatory skills – which are very amenable to early intervention by supporting the parent – infant relationship.

Additionally self consoling is important as it allows the infant to develop essential internal self-regulatory skills as they grow. Observing what strategies, if any, the infant uses when upset tells us a lot about how they are managing and what help they need from a caregiver. A baby who can settle themselves to sleep when they are tired demonstrates excellent self regulatory skills. Sometimes babies are born with these skills whilst others need our support to develop them. Helping parents observe the baby’s ability to self console enables the parent to support the baby’s inherent skills.

Knowing how and when to intervene with support is crucial for getting the infant off to the best start.

In summary, the use of the NBO and NBAS in conjunction with Brazelton principles offers a holistic framework for enhancing infant development. By focusing on habituation, state organization, and regulatory behaviours, we can identify key areas which would benefit from developmental intervention.

The Brazelton approach emphasizes the significance of observing developmental milestones in a supportive context. It helps caregivers understand their infant’s behaviours promoting synchrony of interaction between parent and child which has been shown to be one of the most important factors in child development.

In addition to her work as a Brazelton Master Trainer, Betty Hutchon is co-founder and co-chair on the management board of the charity ‘Ei SMART’. Here she summarises the work of Ei SMART and how the Ei SMART approach complements the Brazelton tools in supporting infant development.

Ei SMART:

Ei SMART (Early Intervention – Sensory, Motor, Attention&regulation and Relationships, Together) is a registered charity whose mission is to lead and transform early neurodevelopmental intervention, so that every infant at risk of developmental challenges due to prematurity or birth trauma is supported using the Ei SMART framework from birth for as long as support is needed.

Ei SMART has been developed with parents of high risk infants and is based on current research and evidence for effective developmental intervention. The implementation of the Ei SMART framework supports infants in all interactions and interventions from birth, throughout neonatal care and beyond. Ei SMART expands the multidisciplinary team’s thinking to focus on the relative contributions of, and the important inter-relationships between Sensory, Motor, Attention & Regulation and Relationships.

Ei SMART has firmly embedded Brazelton principles in its approach to early intervention. As well as identifying ways to support the infant’s emerging Attention&Regulatory skills it also prioritises Relationships and recognises that successful early intervention should be implemented with therapists working Together with the family.

Ei SMART has recently launched several short, parent- friendly developmental videos of everyday activities including lifting and carrying infants, nappy changing and early play. The purpose of these is to show parents simple ways they can support their infant’s development in the first 3 months post term age. We are hoping these videos will help bridge the gap between hospital discharge and community. We would like staff in neonatal units to ensure parents are aware of the videos before discharge – either by posting our leaflets in the parent room or by sharing the link or QR code.

We would love readers to share them on social media and with parents and colleagues.

They can be found on our website with many other free resources:

Follow this link to see the videos: https://eismart.co.uk/videos/

Follow this link to see the PDF leaflets to accompany the videos and they also have the QR codes on them:

PDF leaflets here